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. 2025 May 31;17(5):e85142.
doi: 10.7759/cureus.85142. eCollection 2025 May.

Comparison of Superficial Cervical Plexus Block and Intravenous Morphine for Analgesia in Tympanomastoid Surgeries: A Randomized Double-Blind Control Trial

Dharmesh A Ladhad  1 , Milon Mitragotri  1 , Vikas Joshi  1 , Sanjivani S Jadhav  2 , Madhuri Kurdi  1 , Mahesh Kurugodiyavar  3
Affiliations

Comparison of Superficial Cervical Plexus Block and Intravenous Morphine for Analgesia in Tympanomastoid Surgeries: A Randomized Double-Blind Control Trial

Dharmesh A Ladhad et al. Cureus. .

Abstract

Background and aims Superficial cervical plexus block (SCPB) has been indicated for many neck surgeries including thyroid surgery, carotid endarterectomy, clavicular surgeries, and cochlear implantation, but has not been used perioperatively to provide analgesia for otological surgeries. We hypothesized that the use of this block is not inferior to the use of intravenous morphine for postoperative analgesia. The primary objective was to compare the postoperative Visual Analogue Scale (VAS) scores in those receiving SCPB versus morphine. Secondary objectives included intraoperative hemodynamic stability, postoperative analgesic requirement, nausea and vomiting, and sedation. Material and methods A 100 subjects included in the study received either landmark-guided SCPB (n=50) or intravenous morphine (n=50) intraoperatively after induction. Intraoperative pulse rate and blood pressure were recorded. Postoperatively VAS scores, sedation, analgesic requirement and nausea and vomiting were noted for 24 hours. Results Ninety-six patients were analyzed in both groups, SCPB (n=47) and morphine (n=49). The demographic variables like age, weight, gender, and American Society of Anesthesiologists (ASA) score were comparable in both groups but the duration of surgery was significantly longer in the morphine group (p=0.016). The VAS scores were significantly reduced at one hour, three hours, six hours, 12 hours, and 24 hours in the SCPB group. The mean duration of analgesia was also significantly longer with a decreased analgesic requirement in the SCPB group (13.86±8.04 hour) compared to the morphine group (8.98±4.24 hour) with p-value=0.01. Postoperative nausea, vomiting, and sedation were equivocal in both groups. Conclusion Superficial cervical plexus block was not inferior to intravenous morphine when administered intraoperatively with respect to postoperative analgesia scores, analgesic requirement, and duration of analgesia.

Keywords: clinical otology; middle ear; morphine; opioids; postoperative pain; superficial cervical plexus block; tympanoplasty.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Ethics Committee, Karnataka Institute of Medical Sciences, Hubballi issued approval KIMS: ETHICS: COM: 15:2022-23, dated April 12, 2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Consolidated standards of reporting trials (CONSORT) diagram
n:number
Figure 2
Figure 2. Box and Whisker plot showing visual analogue scale (VAS) at various time points
VAS1: VAS one hour after surgery; VAS2: VAS three hours after surgery; VAS3: VAS six hours after surgery; VAS4: VAS 12 hours after surgery; VAS5: VAS 24 hours after surgery
See this image and copyright information in PMC

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